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1.
FASEB J ; 36 Suppl 12022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35553798

RESUMO

STUDY OBJECTIVE/HYPOTHESIS: Chronic kidney disease (CKD) or progressive loss of kidney function, is a serious health condition that affects 1 in 7 adults or an estimated 37 million Americans. Epidemiological studies have linked CKD with Sleep Apnea (SA), a breathing disorder characterized by erratic breathing, and episodes of hypoxia. However, the mechanisms that underlie the association between CKD and SA are not well understood. Hypoxia Inducible Factor-1α (HIF-1α) is a transcription factor that regulates the body's response to hypoxia. Lysyl oxidase and lysyl oxidase likes (LOX and LOX-Ls) are a group of copper enzymes that are hypoxia responsive and pro-fibrotic. We hypothesized that hypoxia in SA upregulates HIF-1α to drive expression of LOX or LOX-L enzymes, fibrosis, and CKD. MATERIALS & METHODS: Samples from the Sleep and Nephrology and Outcomes Research Study (SNORE), a prospective observational study of sleep disorders in veterans with CKD, were used for this study. The patients were divided into three main groups: CKD with no SA (n=14), CKD with severe SA (n=12) and healthy controls (n=13). RNA from peripheral blood mononuclear cells (PBMC) was isolated using PAXGene Blood RNA tubes (Qiagen). The RNA was then used as a template for reverse transcription, converting it into cDNA and fold changes in gene expression between groups were examined using real time PCR. Differences between groups were compared using nonparametric Mann Whitney U tests and a p-value < 0.05 was considered statistically significant. RESULTS: LOX expression was lower in patients with CKD compared to healthy controls, regardless of SA (CKD with SA: 0.28 ± 0.06 (p=0.04) and CKD without SA: 0.33 ± 0.07 (p=0.09)). There were no significant differences seen in any of the LOX-L expression (LOX-L1 (p=0.84), LOX-L2 (p=0.35), or LOX-L3 (p=0.93)). Similarly, HIF-1α was lower in patients with CKD (CKD with SA: 0.69 ± 1.0 (p=0.47) and CKD without SA: 0.46 ± 0.06 (p=0.01)). There was no statistically significant correlation between LOX and HIF-1α (r=0.04, p=0.83). CONCLUSION: Our results showed that HIF-1α and LOX expression in PBMC was decreased in patients with CKD regardless of if they had SA or not. The mechanisms underlying these observations, the functional significance, and if these changes are representative of tissue LOX expression needs further studies.

2.
Clin Infect Dis ; 2022 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-35438769

RESUMO

BACKGROUND: Recent population-based data are limited regarding influenza-associated hospitalizations in U.S. children. METHODS: We identified children <18 years hospitalized with laboratory-confirmed influenza during 2010-2019 seasons through CDC's Influenza Hospitalization Surveillance Network. Adjusted hospitalization and in-hospital mortality rates were calculated, and multivariable logistic regression was conducted to evaluate risk factors for pneumonia, intensive care unit (ICU) admission, mechanical ventilation, and death. RESULTS: Over 9 seasons, adjusted influenza-associated hospitalization incidence rates ranged from 10-375 per 100,000 persons each season and were highest among infants <6 months. Rates decreased with increasing age. The highest in-hospital mortality rates were observed in children <6 months (0.73 per 100,000 persons). Over time, antiviral treatment significantly increased from 56% to 85% (P < .001) and influenza vaccination rates increased from 33% to 44% (P = .003). Among the 13,235 hospitalized children, 2,676 (20%) of hospitalized children were admitted to the ICU, 2,262 (17%) had pneumonia, 690 (5%) required mechanical ventilation, and 72 (0.5%) died during hospitalization. As compared with those <6 months of age, hospitalized children ≥13 years had higher odds of pneumonia (adjusted odds ratios [aOR], 2.7; 95% confidence interval [CI], 2.1-3.4), ICU admission (aOR, 1.6; 95% CI, 1.3-1.9), mechanical ventilation (aOR, 1.6; 95% CI, 1.1-2.2), and death (aOR, 3.3; 95% CI, 1.2-9.3). CONCLUSIONS: Hospitalization and death rates were greatest in younger children at the population level. Among hospitalized children, however, older children had a higher risk of severe outcomes. Continued efforts to prevent and attenuate influenza in children are needed.

3.
J Acquir Immune Defic Syndr ; 90(1): 6-14, 2022 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-35384920

RESUMO

BACKGROUND: People with HIV (PWH) are at increased risk for invasive pneumococcal disease (IPD). Thirteen-valent pneumococcal conjugate vaccine (PCV13) was recommended for use in US children in 2010 and for PWH aged 19 years or older in 2012. We evaluated the population-level impact of PCV13 on IPD among PWH and non-PWH aged 19 years or older. METHODS: We identified IPD cases from 2008 to 2018 through the Active Bacterial Core surveillance platform. We estimated IPD incidence using the National HIV Surveillance System and US Census Bureau data. We measured percent changes in IPD incidence from 2008 to 2009 to 2017-2018 by HIV status, age group, and vaccine serotype group, including serotypes in recently licensed 15-valent (PCV15) and 20-valent (PCV20) PCVs. RESULTS: In 2008-2009 and 2017-2018, 8.4% (552/6548) and 8.0% (416/5169) of adult IPD cases were among PWH, respectively. Compared with non-PWH, a larger proportion of IPD cases among PWH were in adults aged 19-64 years (94.7%-97.4% vs. 56.0%-60.1%) and non-Hispanic Black people (62.5%-73.0% vs. 16.7%-19.2%). Overall and PCV13-type IPD incidence in PWH declined by 40.3% (95% confidence interval: -47.7 to -32.3) and 72.5% (95% confidence interval: -78.8 to -65.6), respectively. In 2017-2018, IPD incidence was 16.8 (overall) and 12.6 (PCV13 type) times higher in PWH compared with non-PWH; PCV13, PCV15/non-PCV13, and PCV20/non-PCV15 serotypes comprised 21.5%, 11.2%, and 16.5% of IPD in PWH, respectively. CONCLUSIONS: Despite reductions post-PCV13 introduction, IPD incidence among PWH remained substantially higher than among non-PWH. Higher-valent PCVs provide opportunities to reduce remaining IPD burden in PWH.


Assuntos
Infecções por HIV , Infecções Pneumocócicas , Adulto , Criança , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Incidência , Lactente , Pessoa de Meia-Idade , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas , Sorogrupo , Estados Unidos/epidemiologia , Vacinas Conjugadas , Adulto Jovem
4.
J Infect Dis ; 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35481950

RESUMO

BACKGROUND: Antibiotic-nonsusceptible invasive pneumococcal disease (NS-IPD) incidence declined dramatically in the United States following introduction of pneumococcal conjugate vaccines (PCVs) into the infant immunization schedule (7-valent PCV7 in 2000, replaced by the 13-valent PCV13 in 2010). We evaluated the long-term impact of PCVs on NS-IPD. METHODS: We identified IPD cases through the Centers for Disease Control Active Bacterial Core surveillance during 1998-2018. Isolates intermediate or resistant to ≥1 antibiotic class were classified as nonsusceptible. We calculated annual rates of IPD (cases per 100,000 persons). RESULTS: From 1998 through 2018, NS-IPD incidence decreased from 43.9 to 3.2 among children <5 years and from 19.8 to 9.4 among adults ≥65 years. Incidence of vaccine-type NS-IPD decreased in all age groups, while incidence of NVT NS-IPD increased in all age groups; the greatest absolute increase in NVT NS-IPD occurred among adults ≥65 years (2.3 to 7.2). During 2014-18, NVTs 35B, 33F, 22F, and 15A were the most common NS-IPD serotypes. CONCLUSIONS: NS-IPD incidence decreased following PCV7 and PCV13 introduction in the United States. However, recent increases in NVT NS-IPD, most pronounced among older adults, have been observed. New higher valency PCVs containing the most common nonsusceptible serotypes, including 22F and 33F, could help further reduce NS-IPD.

5.
Open Forum Infect Dis ; 9(5): ofac131, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35450083

RESUMO

Background: Diabetes mellitus (DM) is common among older adults hospitalized with influenza, yet data are limited on the impact of DM on risk of severe influenza-associated outcomes. Methods: We included adults aged ≥65 years hospitalized with influenza during 2012-2013 through 2016-2017 from the Influenza Hospitalization Surveillance Network (FluSurv-NET), a population-based surveillance system for laboratory-confirmed influenza-associated hospitalizations conducted in defined counties within 13 states. We calculated population denominators using the Centers for Medicare and Medicaid Services county-specific DM prevalence estimates and National Center for Health Statistics population data. We present pooled rates and rate ratios (RRs) of intensive care unit (ICU) admission, pneumonia diagnosis, mechanical ventilation, and in-hospital death for persons with and without DM. We estimated RRs and 95% confidence intervals (CIs) using meta-analysis with site as a random effect in order to control for site differences in the estimates. Results: Of 31 934 hospitalized adults included in the analysis, 34% had DM. Compared to those without DM, adults with DM had higher rates of influenza-associated hospitalization (RR, 1.57 [95% CI, 1.43-1.72]), ICU admission (RR, 1.84 [95% CI, 1.67-2.04]), pneumonia (RR, 1.57 [95% CI, 1.42-1.73]), mechanical ventilation (RR, 1.95 [95% CI, 1.74-2.20]), and in-hospital death (RR, 1.48 [95% CI, 1.23-1.80]). Conclusions: Older adults with DM have higher rates of severe influenza-associated outcomes compared to those without DM. These findings reinforce the importance of preventing influenza virus infections through annual vaccination, and early treatment of influenza illness with antivirals in older adults with DM.

6.
PLoS One ; 17(3): e0264890, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35263382

RESUMO

BACKGROUND: Respiratory syncytial virus (RSV) can cause severe disease in adults with cardiopulmonary conditions, such as congestive heart failure (CHF). We quantified the rate of RSV-associated hospitalization in adults by CHF status using population-based surveillance in the United States. METHODS: Population-based surveillance for RSV (RSV-NET) was performed in 35 counties in seven sites during two respiratory seasons (2015-2017) from October 1-April 30. Adults (≥18 years) admitted to a hospital within the surveillance catchment area with laboratory-confirmed RSV identified by clinician-directed testing were included. Presence of underlying CHF was determined by medical chart abstraction. We calculated overall and age-stratified (<65 years and ≥65 years) RSV-associated hospitalization rates by CHF status. Estimates were adjusted for age and the under-detection of RSV. We also report rate differences (RD) and rate ratios (RR) by comparing the rates for those with and without CHF. RESULTS: 2042 hospitalized RSV cases with CHF status recorded were identified. Most (60.2%, n = 1230) were ≥65 years, and 28.3% (n = 577) had CHF. The adjusted RSV hospitalization rate was 26.7 (95% CI: 22.2, 31.8) per 10,000 population in adults with CHF versus 3.3 (95% CI: 3.3, 3.3) per 10,000 in adults without CHF (RR: 8.1, 95% CI: 6.8, 9.7; RD: 23.4, 95% CI: 18.9, 28.5). Adults with CHF had higher rates of RSV-associated hospitalization in both age groups (<65 years and ≥65 years). Adults ≥65 years with CHF had the highest rate (40.5 per 10,000 population, 95% CI: 35.1, 46.6). CONCLUSIONS: Adults with CHF had 8 times the rate of RSV-associated hospitalization compared with adults without CHF. Identifying high-risk populations for RSV infection can inform future RSV vaccination policies and recommendations.


Assuntos
Insuficiência Cardíaca , Influenza Humana , Infecções por Vírus Respiratório Sincicial , Vírus Sincicial Respiratório Humano , Adulto , Idoso , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/epidemiologia , Hospitalização , Humanos , Lactente , Influenza Humana/epidemiologia , Estados Unidos/epidemiologia
7.
Clin Pathol ; 15: 2632010X221076379, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35187481

RESUMO

INTRODUCTION: Invasive Breast carcinoma-No special type (NST) is the most common breast malignancy accounting for 95% of breast cancers. Study of predictive and prognostic immunohistochemical markers estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (Her2neu) expression are crucial for treatment planning. MATERIALS AND METHODS: In the present study we studied the hormonal profile in 303 sporadic breast cancers and BRCA1 protein expression in these patients along with its clinico-pathological correlation. RESULTS: In our patient population, Triple negative Breast carcinoma (TNBC) (104/303; 34.3%) was the most common luminal subtype followed by Luminal A 74/303; 24.4%), Her2 enriched (65/303; 21.5%), and Luminal B (60/303; 19.8%) respectively. This contrasts with many western studies which commonly report Luminal A being the largest subgroup. BRCA1 protein loss was more prominently seen in TNBC (64/104;61.5%) highlighting the possibility that high grade tumors are more susceptible to some epigenetic modifications leading to higher likelihood of loss of BRCA1 protein. CONCLUSION: Hence, we conclude that like hereditary cases of breast carcinoma with BRCA1 mutation; BRCA1 loss is also more likely in sporadic TNBC cases.

8.
Ann Intern Med ; 175(2): 149-158, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34958603

RESUMO

BACKGROUND: Pregnant women may be at increased risk for severe influenza-associated outcomes. OBJECTIVE: To describe characteristics and outcomes of hospitalized pregnant women with influenza. DESIGN: Repeated cross-sectional study. SETTING: The population-based U.S. Influenza Hospitalization Surveillance Network during the 2010-2011 through 2018-2019 influenza seasons. PATIENTS: Pregnant women (aged 15 to 44 years) hospitalized with laboratory-confirmed influenza identified through provider-initiated or facility-based testing practices. MEASUREMENTS: Clinical characteristics, interventions, and in-hospital maternal and fetal outcomes were obtained through medical chart abstraction. Multivariable logistic regression was used to evaluate the association between influenza A subtype and severe maternal influenza-associated outcomes, including intensive care unit (ICU) admission, mechanical ventilation, extracorporeal membrane oxygenation, or in-hospital death. RESULTS: Of 9652 women aged 15 to 44 years and hospitalized with influenza, 2690 (27.9%) were pregnant. Among the 2690 pregnant women, the median age was 28 years, 62% were in their third trimester, and 42% had at least 1 underlying condition. Overall, 32% were vaccinated against influenza and 88% received antiviral treatment. Five percent required ICU admission, 2% required mechanical ventilation, and 0.3% (n = 8) died. Pregnant women with influenza A H1N1 were more likely to have severe outcomes than those with influenza A H3N2 (adjusted risk ratio, 1.9 [95% CI, 1.3 to 2.8]). Most women (71%) were still pregnant at hospital discharge. Among 754 women who were no longer pregnant at discharge, 96% had a pregnancy resulting in live birth, and 3% experienced fetal loss. LIMITATION: Maternal and fetal outcomes that occurred after hospital discharge were not captured. CONCLUSION: Over 9 influenza seasons, one third of reproductive-aged women hospitalized with influenza were pregnant. Influenza A H1N1 was associated with more severe maternal outcomes. Pregnant women remain a high-priority target group for vaccination. PRIMARY FUNDING SOURCE: Centers for Disease Control and Prevention.


Assuntos
Vírus da Influenza A Subtipo H1N1 , Influenza Humana , Complicações Infecciosas na Gravidez , Adulto , Estudos Transversais , Feminino , Mortalidade Hospitalar , Hospitalização , Humanos , Vírus da Influenza A Subtipo H3N2 , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Gestantes
9.
Infect Control Hosp Epidemiol ; : 1-7, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34607624

RESUMO

OBJECTIVE: To estimate population-based rates and to describe clinical characteristics of hospital-acquired (HA) influenza. DESIGN: Cross-sectional study. SETTING: US Influenza Hospitalization Surveillance Network (FluSurv-NET) during 2011-2012 through 2018-2019 seasons. METHODS: Patients were identified through provider-initiated or facility-based testing. HA influenza was defined as a positive influenza test date and respiratory symptom onset >3 days after admission. Patients with positive test date >3 days after admission but missing respiratory symptom onset date were classified as possible HA influenza. RESULTS: Among 94,158 influenza-associated hospitalizations, 353 (0.4%) had HA influenza. The overall adjusted rate of HA influenza was 0.4 per 100,000 persons. Among HA influenza cases, 50.7% were 65 years of age or older, and 52.0% of children and 95.7% of adults had underlying conditions; 44.9% overall had received influenza vaccine prior to hospitalization. Overall, 34.5% of HA cases received ICU care during hospitalization, 19.8% required mechanical ventilation, and 6.7% died. After including possible HA cases, prevalence among all influenza-associated hospitalizations increased to 1.3% and the adjusted rate increased to 1.5 per 100,000 persons. CONCLUSIONS: Over 8 seasons, rates of HA influenza were low but were likely underestimated because testing was not systematic. A high proportion of patients with HA influenza were unvaccinated and had severe outcomes. Annual influenza vaccination and implementation of robust hospital infection control measures may help to prevent HA influenza and its impacts on patient outcomes and the healthcare system.

10.
MMWR Morb Mortal Wkly Rep ; 70(36): 1255-1260, 2021 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-34499627

RESUMO

Although COVID-19-associated hospitalizations and deaths have occurred more frequently in adults,† COVID-19 can also lead to severe outcomes in children and adolescents (1,2). Schools are opening for in-person learning, and many prekindergarten children are returning to early care and education programs during a time when the number of COVID-19 cases caused by the highly transmissible B.1.617.2 (Delta) variant of SARS-CoV-2, the virus that causes COVID-19, is increasing.§ Therefore, it is important to monitor indicators of severe COVID-19 among children and adolescents. This analysis uses Coronavirus Disease 2019-Associated Hospitalization Surveillance Network (COVID-NET)¶ data to describe COVID-19-associated hospitalizations among U.S. children and adolescents aged 0-17 years. During March 1, 2020-August 14, 2021, the cumulative incidence of COVID-19-associated hospitalizations was 49.7 per 100,000 children and adolescents. The weekly COVID-19-associated hospitalization rate per 100,000 children and adolescents during the week ending August 14, 2021 (1.4) was nearly five times the rate during the week ending June 26, 2021 (0.3); among children aged 0-4 years, the weekly hospitalization rate during the week ending August 14, 2021, was nearly 10 times that during the week ending June 26, 2021.** During June 20-July 31, 2021, the hospitalization rate among unvaccinated adolescents (aged 12-17 years) was 10.1 times higher than that among fully vaccinated adolescents. Among all hospitalized children and adolescents with COVID-19, the proportions with indicators of severe disease (such as intensive care unit [ICU] admission) after the Delta variant became predominant (June 20-July 31, 2021) were similar to those earlier in the pandemic (March 1, 2020-June 19, 2021). Implementation of preventive measures to reduce transmission and severe outcomes in children is critical, including vaccination of eligible persons, universal mask wearing in schools, recommended mask wearing by persons aged ≥2 years in other indoor public spaces and child care centers,†† and quarantining as recommended after exposure to persons with COVID-19.§§.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Adolescente , COVID-19/prevenção & controle , Vacinas contra COVID-19/administração & dosagem , Criança , Pré-Escolar , Humanos , Lactente , Recém-Nascido , SARS-CoV-2/isolamento & purificação , Índice de Gravidade de Doença , Estados Unidos/epidemiologia , Vacinação/estatística & dados numéricos
11.
Pediatrics ; 148(4)2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34470815

RESUMO

BACKGROUND: Antiviral treatment is recommended for hospitalized patients with suspected and confirmed influenza, but evidence is limited among children. We evaluated the effect of antiviral treatment on hospital length of stay (LOS) among children hospitalized with influenza. METHODS: We included children <18 years hospitalized with laboratory-confirmed influenza in the US Influenza Hospitalization Surveillance Network. We collected data for 2 cohorts: 1 with underlying medical conditions not admitted to the ICU (n = 309, 2012-2013) and an ICU cohort (including children with and without underlying conditions; n = 299, 2010-2011 to 2012-2013). We used a Cox model with antiviral receipt as a time-dependent variable to estimate hazard of discharge and a Kaplan-Meier survival analysis to determine LOS. RESULTS: Compared with those not receiving antiviral agents, LOS was shorter for those treated ≤2 days after illness onset in both the medical conditions (adjusted hazard ratio: 1.37, P = .02) and ICU (adjusted hazard ratio: 1.46, P = .007) cohorts, corresponding to 37% and 46% increases in daily discharge probability, respectively. Treatment ≥3 days after illness onset had no significant effect in either cohort. In the medical conditions cohort, median LOS was 3 days for those not treated versus 2 days for those treated ≤2 days after symptom onset (P = .005). CONCLUSIONS: Early antiviral treatment was associated with significantly shorter hospitalizations in children with laboratory-confirmed influenza and high-risk medical conditions or children treated in the ICU. These results support Centers for Disease Control and Prevention recommendations for prompt empiric antiviral treatment in hospitalized patients with suspected or confirmed influenza.


Assuntos
Antivirais/uso terapêutico , Influenza Humana/tratamento farmacológico , Tempo de Internação , Adolescente , Criança , Pré-Escolar , Feminino , Hospitalização , Humanos , Lactente , Influenza Humana/complicações , Unidades de Terapia Intensiva Pediátrica , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Tempo para o Tratamento
12.
Indian J Nucl Med ; 36(2): 193-194, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34385793

RESUMO

Myeloid sarcoma is a rare extramedullary manifestation of acute myeloid leukemia (AML) that often presents during remission or disease relapse. The most common site of relapse being, however, many rare sites has been reported in the existing literature. We are herewith presenting the case of a 27-year-old patient of AML who showed an unusual site of relapse on fluorodeoxyglucose positron emission tomography/computed tomography scan.

13.
Artigo em Inglês | MEDLINE | ID: mdl-34360496

RESUMO

Sustainable Development Goal target 6.2 calls for universal access to adequate and equitable sanitation, setting a more ambitious standard for 'safely managed sanitation services'. On-site sanitation systems (e.g., septic tanks) are widely used in low- and middle-income countries (LMICs). However, the lack of indicators for assessing fecal exposure risks presents a barrier to monitoring safely managed services. Furthermore, geographic diversity and frequency of disasters require a more nuanced approach to risk-informed decision-making. Taking Indonesia as an example, the purpose of this paper is to provide insights into current status and practices for on-site sanitation services in the contexts of LMICs. Using a dataset from a national socio-economic survey (n = 295,155) coupled with village census (n = 83,931), we assessed (1) household sanitation practices across Indonesia stratified by city-level population density and meteorological factors, (2) factors associated with septic tank emptying practice, and (3) inequalities in potential fecal exposure as measured by population density and WASH access by wealth quintile. We found a high reliance on on-site sanitation facilities (80.0%), almost half of which are assumed to be 'uncontained' septic tanks and one in ten facilities discharging untreated waste directly into the environment. The most densely populated areas had the highest rates of septic tank emptying, though emptying rates were just 17.0%, while in the lowest population density group, emptying was rarely reported. Multivariate regression analysis demonstrated an association between flooding and drought occurrence and septic tank emptying practice. Higher groundwater usage for drinking among poorer households suggests unsafe sanitation may disproportionally affect the poor. Our study underscores the urgent need to strengthen the monitoring of on-site sanitation in LMICs by developing contextualized standards. Furthermore, the inequalities in potential fecal exposure require greater attention and tailored support mechanisms to ensure the poorest gain access to safely managed sanitation services.


Assuntos
Características da Família , Saneamento , Fezes , Humanos , Indonésia , Pobreza , Abastecimento de Água
14.
J Family Med Prim Care ; 10(5): 1863-1867, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34195117

RESUMO

BACKGROUND: The Geriatric Depression Scale (GDS-30) is a popular instrument that has been ratified and is being used around the world as a screening tool for over three decades. However, a validated version of the scale is not available for use among speakers of Malayalam. In this paper, we elaborate on the procedure involved in the translation and validation of the GDS-30 from the official English version into Malayalam, the hurdles encountered in the process, and how they were overcome. METHODS: The steps recommended by the World Health Organization (WHO) were applied for the translation of the original questionnaire. This involved initial forward translation of the English questionnaire, discussion by an expert panel, back-translation, pre-testing, and pilot testing of the final version. The Malayalam translation thus obtained was administered to 100 elderly persons in the community. These individuals were then examined by a qualified doctor, who had received the necessary training from a consultant psychiatrist in the diagnosis of depressive disorders. This doctor evaluated the study subjects clinically using theInternational Classification of Diseases-tenth revision (ICD-10) criteria for the diagnosis of depression, which is considered as the gold standard. Sensitivity, specificity, Cronbach'salpha, and split-half reliability were calculated to determine validity. RESULTS: The translated scale yielded a sensitivity of 87.20%, a specificity of 73.80%, an area under the Receiving Operator Curve (ROC) of 0.814, Cronbach's α of 0.920, and split-half reliability of 0.897, thereby proving to be a valid screening tool. CONCLUSION: The Malayalam translation of the GDS-30 is a valid instrument to screen for depression in an elderly Malayalam-speaking population.

15.
Cancer ; 127(20): 3872-3880, 2021 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-34161610

RESUMO

BACKGROUND: Many young women with breast cancer undergo fertility preservation (FP) before cancer treatment. This study examined the impact of FP on breast cancer outcomes. METHODS: The authors performed a retrospective cohort study of 272 women aged 20 to 45 years with newly diagnosed stage 0 to III breast cancer who underwent an FP consultation between 2005 and 2017. Among these women, 123 (45.2%) underwent FP (fertility preservation-positive [FP+]). The remaining 149 women did not undergo FP (fertility preservation-negative [FP-]). RESULTS: The characteristics at enrollment were similar with the exception of ethnicity (FP+, 87.8% White; FP-, 67.8% White; P = .002) and BRCA status (FP+, 27.7% BRCA+; FP-, 15.5% BRCA+; P = .021). The median follow-up was approximately 4 years. Women who underwent FP had longer times to first treatment (FP+, 37 days; FP-, 31 days; adjusted hazard ratio [aHR], 0.74; confidence interval [CI], 0.56-0.99) and neoadjuvant chemotherapy (FP+, 36 days; FP-, 26 days; aHR, 0.41; CI, 0.24-0.68) and from surgery to adjuvant chemotherapy (FP+, 41 days; FP-, 33 days; aHR, 0.58; CI, 0.38-0.90). Adjusted 3- and 5-year invasive disease-free survival (IDFS) rates were comparable between the 2 groups (3-year IDFS: FP+, 85.4%; FP-, 79.4%; P = .411; 5-year IDFS: FP+, 73.7%; FP-, 67.1%; P = .288). Similarly, no difference in overall survival (OS) was observed between the 2 groups (3-year OS: FP+, 95.5%; FP-, 93.5%; P = .854; 5-year OS: FP+, 84.2%; FP-, 81.4%; P = .700). CONCLUSIONS: FP after a breast cancer diagnosis delays the time to treatment by a small amount, but this delay does not lead to inferior IDFS or OS.


Assuntos
Neoplasias da Mama , Preservação da Fertilidade , Adulto , Neoplasias da Mama/tratamento farmacológico , Quimioterapia Adjuvante , Feminino , Humanos , Pessoa de Meia-Idade , Terapia Neoadjuvante , Estudos Retrospectivos , Adulto Jovem
16.
Clin Infect Dis ; 73(9): 1617-1624, 2021 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33993217

RESUMO

BACKGROUND: Since the introduction of Haemophilus influenzae serotype b (Hib) conjugate vaccines in the United States, invasive H. influenzae disease epidemiology has changed, and racial disparities have not been recently described. METHODS: Active population- and laboratory-based surveillance for H. influenzae was conducted through Active Bacterial Core surveillance at 10 US sites. Data from 2008-2017 were used to estimate projected nationwide annual incidence, as cases per 100 000. RESULTS: During 2008-2017, Active Bacterial Core surveillance identified 7379 H. influenzae cases. Of 6705 patients (90.9%) with reported race, 76.2% were White, 18.6% were Black, 2.8% were Asian/Pacific Islander, and 2.4% were American Indian or Alaska Native (AI/AN). The nationwide annual incidence was 1.8 cases/100 000. By race, incidence was highest among AI/AN populations (3.1) and lowest among Asian/Pacific Islander populations (0.8). Nontypeable H. influenzae caused the largest incidence within all races (1.3), with no striking disparities identified. Among AI/AN children aged <5 years, incidence of H. influenzae serotype a (Hia) was 16.7 times higher and Hib incidence was 22.4 times higher than among White children. Although Hia incidence was lower among White and Black populations than among AI/AN populations, Hia incidence increased 13.6% annually among White children and 40.4% annually among Black children aged <5 years. CONCLUSIONS: While nontypeable H. influenzae causes the largest H. influenzae burden overall, AI/AN populations experience disproportionately high rates of Hia and Hib, with the greatest disparity among AI/AN children aged <5 years. Prevention tools are needed to reduce disparities affecting AI/AN children and address increasing Hia incidence in other communities.


Assuntos
Infecções por Haemophilus , Vacinas Anti-Haemophilus , Haemophilus influenzae tipo b , Criança , Infecções por Haemophilus/epidemiologia , Haemophilus influenzae , Humanos , Incidência , Lactente , Sorogrupo , Estados Unidos/epidemiologia
17.
Fertil Res Pract ; 7(1): 12, 2021 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-34049598

RESUMO

BACKGROUND: A number of studies have looked at dual triggers with hCG and GnRH agonist (GnRHa) in varying doses, but the question remains: what is the optimal dose of hCG to minimize ovarian hyperstimulation syndrome (OHSS) and still offer adequate pregnancy rates? The purpose of this study was to compare pregnancy and OHSS rates following dual trigger for oocyte maturation with GnRHa and a low-dose hCG versus hCG alone. A secondary objective was the assess pregnancy outcomes in subsequent frozen cycles for the same population. METHODS: A total of 963 women < 41 years old, with a BMI 18-40 kg/m2 and an AMH > 2 ng/mL who underwent fresh autologous in vitro fertilization (IVF) with GnRH antagonist protocol at a University-based fertility center were included in this retrospective cohort study. Those who received a low dose dual trigger with hCG (1000u) and GnRHa (2 mg) were compared to those who received hCG alone (10,000u hCG/250-500 µg Ovidrel). Differences in implantation rates, pregnancy, live birth, and OHSS were investigated. RESULTS: The dual trigger group was younger (mean 33.6 vs 34.1 years), had a higher AMH (6.3 vs 4.9 ng/mL,) more oocytes retrieved (18.1 vs 14.9) and a higher fertilized oocyte rate (80% vs 77%) compared with the hCG only group. Yet, the dual trigger group had a lower probability of clinical pregnancy (gestational sac, 43.4% vs 52.8%) and live birth (33.4% vs 45.8%), all of which were statistically significant. There were 3 cases of OHSS, all in the hCG-only trigger group. In subsequent frozen cycles, pregnancy rates were comparable between the two groups. CONCLUSIONS: The dual trigger group had a better prognosis based on age and AMH levels and had better stimulation outcomes, but significantly worse pregnancy outcomes, suggesting the low dose hCG (1000u) in the dual trigger may not have provided adequate luteal support, compared to an hCG-only trigger (10,000u hCG/250-500 µg Ovidrel). Interestingly, the pregnancy rates were comparable in subsequent frozen cycles, further supporting the hypothesis that the issue lies in inadequate luteal phase support, rather than embryo quality. Based on these findings, our program has changed the protocol to 1500u of hCG in a dual trigger.

18.
Head Neck Pathol ; 15(4): 1137-1146, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33840044

RESUMO

Collision tumor is the occurrence of two histologically and morphologically distinct tumors within the same organ with no histological admixture. Collision tumors of the thyroid are extremely rare constituting < 1% of all thyroid tumors. Clinical profiles and pathological features of Medullary thyroid carcinoma (MTC) and Papillary thyroid carcinoma (PTC) presenting as Collision tumors of thyroid, diagnosed between 2009 and 2019, at a tertiary care cancer center were retrospectively analyzed. Collision tumors comprised 4.7% of all MTC cases diagnosed over 10 years. A total of 21 cases (11males, 11 females, M:F = 1) were retrieved with the mean age of patients being 45.33 years (range 26-77 years). More than half of PTCs involved the right lobe of the thyroid (66.6%). About half (53.4%) of MTCs affected the left lobe. Imaging done pre-operatively failed to identify the smaller second tumor in 60% of the cases with both tumours in separate lobes. Pre-operative FNAC showed only MTC in all 8 cases in which it was done. Papillary microcarcinoma (m-PTC) was seen in 85.7% cases, with one case of multifocal m-PTC. MTC (mean size 3.12 cm), on an average, was 3 times larger than the PTC (mean size 0.91 cm). The histological variants of MTC included-oncocytic (1/21, 4.7%), spindle cell (1/21, 4.7%), epithelial (3/21, 14.2%) and classical (16/21, 76.2%) and of PTC included classic PTC (12/21, 57.14%), Hurthle cell (2/21, 9.52%), tall cell (1/21, 4.76%) and follicular variant of PTC (6/21, 28.57%). The microscopic extrathyroidal extension (ETE) due to MTC and PTC component was 42.8% and 9.5% respectively. Lymph node metastasis was seen in 16 (76.2%) cases; 87.5% (14/16) of which were contributed by MTC, 12.5% (2/16) by PTC alone, and 12.5% (2/16) cases showed metastasis from both MTC and PTC. MTC had a higher stage than PTC in 85.5% of cases. Collision tumors of the thyroid are exceedingly rare, and possibly underdiagnosed due to variation in sampling techniques, especially of the grossly "normal lobe". The low incidence in our cohort is in favor of the "Chance theory" of co-occurrence. This diagnosis is important due to its therapeutic and prognostic implications.


Assuntos
Carcinoma Neuroendócrino/patologia , Neoplasias Primárias Múltiplas/patologia , Câncer Papilífero da Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adulto , Idoso , Carcinoma Papilar/patologia , Feminino , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Atenção Terciária à Saúde
19.
PLoS One ; 16(4): e0249636, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33831050

RESUMO

Ryegrasses (Lolium spp.) and fescues (Festuca spp.) are closely related and widely cultivated perennial forage grasses. As such, resilience in the face of abiotic stresses is an important component of their traits. We have compared patterns of differentially expressed genes (DEGs) in roots and leaves of two perennial ryegrass genotypes and a single genotype of each of a festulolium (predominantly Italian ryegrass) and meadow fescue with the onset of water stress, focussing on overall patterns of DEGs and gene ontology terms (GOs) shared by all four genotypes. Plants were established in a growing medium of vermiculite watered with nutrient solution. Leaf and root material were sampled at 35% (saturation) and, as the medium dried, at 15%, 5% and 1% estimated water contents (EWCs) and RNA extracted. Differential gene expression was evaluated comparing the EWC sampling points from RNAseq data using a combination of analysis methods. For all genotypes, the greatest numbers of DEGs were identified in the 35/1 and 5/1 comparisons in both leaves and roots. In total, 566 leaf and 643 root DEGs were common to all 4 genotypes, though a third of these leaf DEGs were not regulated in the same up/down direction in all 4 genotypes. For roots, the equivalent figure was 1% of the DEGs. GO terms shared by all four genotypes were often enriched by both up- and down-regulated DEGs in the leaf, whereas generally, only by either up- or down-regulated DEGs in the root. Overall, up-regulated leaf DEGs tended to be more genotype-specific than down-regulated leaf DEGs or root DEGs and were also associated with fewer GOs. On average, only 5-15% of the DEGs enriching common GO terms were shared by all 4 genotypes, suggesting considerable variation in DEGs between related genotypes in enacting similar biological processes.


Assuntos
Desidratação , Festuca/metabolismo , Regulação da Expressão Gênica de Plantas , Lolium/metabolismo , Folhas de Planta/metabolismo , Proteínas de Plantas/metabolismo , Raízes de Plantas/metabolismo , Festuca/genética , Festuca/crescimento & desenvolvimento , Perfilação da Expressão Gênica , Ontologia Genética , Genótipo , Lolium/genética , Lolium/crescimento & desenvolvimento , Fenótipo , Folhas de Planta/genética , Folhas de Planta/crescimento & desenvolvimento , Proteínas de Plantas/genética , Raízes de Plantas/genética , Raízes de Plantas/crescimento & desenvolvimento
20.
Front Plant Sci ; 12: 637956, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33815444

RESUMO

Brachiaria (Trin.) Griseb. (syn. Urochloa P. Beauv.) is a C4 grass genus belonging to the Panicoideae. Native to Africa, these grasses are now widely grown as forages in tropical areas worldwide and are the subject of intensive breeding, particularly in South America. Tolerance to abiotic stresses such as aluminum and drought are major breeding objectives. In this study, we present the transcriptomic profiling of leaves and roots of three Brachiaria interspecific hybrid genotypes with the onset of water stress, Br12/3659-17 (gt-17), Br12/2360-9 (gt-9), and Br12/3868-18 (gt-18), previously characterized as having good, intermediate and poor tolerance to drought, respectively, in germplasm evaluation programs. RNA was extracted from leaf and root tissue of plants at estimated growing medium water contents (EWC) of 35, 15, and 5%. Differentially expressed genes (DEGs) were compared between different EWCs, 35/15, 15/5, and 35/5 using DESeq2. Overall, the proportions of DEGs enriched in all three genotypes varied in a genotype-dependent manner in relation to EWC comparison, with intermediate and sensitive gt-9 and gt-18 being more similar to each other than to drought tolerant gt-17. More specifically, GO terms relating to carbohydrate and cell wall metabolism in the leaves were enriched by up-regulated DEGs in gt-9 and gt-18, but by down-regulated DEGs in gt-17. Across all genotypes, analysis of DEG enzyme activities indicated an excess of down-regulated putative apoplastic peroxidases in the roots as water stress increased. This suggests that changes in root cell-wall architecture may be an important component of the response to water stress in Brachiaria.

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